The treatment of children with craniofacial disorders requires a comprehensive team approach. The combined expertise of the multidisciplinary Mayo Clinic craniofacial disorders team optimizes the holistic care of the child. The team includes specialists from Pediatric Neurosurgery, Plastic and Reconstructive Surgery, Child and Adolescent Neurology and Pediatric Medical Genetics. This team has the most current diagnostic and treatment options available.
Premature closure of growth plates in the skull cause abnormal growth patterns of the face and skull. The altered growth results in an abnormal head shape. The actual shape of an affected infant's head depends on which growth plates closed prematurely.
An infant's skull is made up of a collection of separate bones. The spaces between these bones are called sutures. The brain grows rapidly in an infant. In order to make room for the growing brain, the skull also grows rapidly. Growth of the skull takes place at the sutures. Premature fusion or closure of these sutures is called craniosynostosis. In a child with craniosynostosis, the brain continues to grow. However, the skull will not grow where the suture is closed. Compensatory growth occurs at adjacent sutures, resulting in an abnormal head shape.
The most common of the synostoses are the following:
There is a distinctive head shape associated with the premature closing of each suture. Since most head growth occurs within the first year of life, the synostosis is usually diagnosed and treated early in life. Often times, the diagnosis of craniosynostosis is easily made by physical examination alone. Sometimes, plain skull films or a CT scan may be helpful.
Some infants may have a premature closing of more than one suture. Infants with more than one suture involved may have a genetic syndrome. Examples of these include Crouzon, Apert or Pfeiffer syndromes. Infants with a genetic syndrome may have other anomalies as well. Therefore, treatment at a facility with a comprehensive team approach is necessary. These children require a multidisciplinary team of specialists for the management of their care.
An abnormal head shape may also result from a positioning deformity. Due to confinement during pregnancy or tightness of neck muscles, the infant sleeps with its head always turned to the same side. These babies present with a flattening of the back of their skull on the side on which they sleep. These infants also may have a bulging forehead and a forward displacement of the ear on the same side as the flattening, and bulging on the opposite side of the back of the head. The vast majority of these infants do not have a true synostosis, but rather a functional lambdoid synostosis. The treatment for these particular infants often does not involve surgery. Usually, vigorous repositioning techniques to keep the infant off the flat spot is often recommended. However, if physical examination reveals that the infant's neck muscles are tight, an assessment by a Physical Medicine physician may be beneficial. These doctors may be able to recommend some neck stretching exercises. Occasionally, a molding device or helmet may be employed. At Mayo Clinic, all of these treatment options are available and discussed on an individual basis.
Will my child need surgery to treat the craniosynostosis?
If your child has positional plagiocephaly or functional lambdoid synostosis, often this can be corrected with positioning techniques. In this case, surgery is usually not recommended. However, if your child has a premature closure of one or more sutures, surgery may be recommended. The type of surgery is based upon which suture(s) is involved. It is important to seek care at a facility with a multitude of diagnostic and surgical capabilities.
Will my child need more than one surgery?
In most cases, children with only one suture involved require only one surgical procedure. However, those children with multiple sutures involved or those with craniofacial abnormalities may require staged surgical interventions. Communication between the members of the comprehensive team and the family is of extreme importance. Therefore, seek care at a facility like Mayo Clinic that is equipped to handle the multidisciplinary needs of the child.
Why are both a neurosurgeon and a plastic surgeon involved in the care of my child?
During surgery, the role of the neurosurgeon is focused on the skull and protection of the underlying brain. The plastic surgeon's role is focused on the facial deformity and recontouring the skull. This combined expertise optimizes care.
Could there be a problem with my child's brain?
In most cases, the brain is not adversely affected in children with single suture involvement. In some cases, when children have a genetic syndrome or multi-suture involvement, there may be some concern about increased intracranial pressure. This increased pressure may have a negative impact on the brain if not adequately treated. Therefore, it is important to seek care at a facility that is experienced in dealing with the multidisciplinary needs of the child. At Mayo Clinic, the development of the child is followed closely and continually assessed through intensive neuropsychological testing.
My baby has positional molding. How should I position him?
Several years ago, researchers determined that infants who were placed on their stomachs during sleep had an increased incidence of SIDS (Sudden Infant Death Syndrome). Therefore, pediatricians have recommended that infants avoid being positioned on their stomachs, but rather on their sides or backs. Often you will find that an infant prefers to sleep with the head turned to only one side. This may cause flatness on the preferred side. Therefore, parents should try to keep the baby off of that side. One helpful hint is to keep colorful toys on the opposite side so the infant wants to look the other way. Commercially made wedges are also available for positioning infants. Once the infant begins to roll over, it is more difficult, but not impossible, to reposition. Repositioning takes diligence on the part of the parents.
The care of a child with a craniofacial disorder can be multifaceted. It is important to have an interdisciplinary team approach. The Mayo Clinic Craniofacial Clinic provides intensive, coordinated care for these children. Team members may include individuals from the following specialties: Neurosurgery, Plastic and Reconstructive Surgery, Medical Genetics, Psychology, Speech Pathology, Orthodontics, Medical Social Services and Otorhinolaryngology.
A variety of written materials are available for review in the Mayo Clinic Patient Health and Education Center. Health education specialists are also available to help families locate pertinent resources. "Preparing for Surgery" is a Patient and Health Education Program offered for children who need surgery. This program helps children gain a better understanding of what to expect during the hospital stay. Family members also are encouraged to attend. This class is offered free of charge to the patient and family. Both the Neurosurgery and Plastic and Reconstructive Surgery departments have a nursing staff that is able to provide individualized patient education.